Chances are you know someone who has had a hysterectomy. It is the second most frequently performed surgery for women, after C-sections, according to the National Institutes of Health. About one in three women will have a hysterectomy by age 60. 

“Hysterectomy is considered a major surgery and is very safe when performed by a board-certified gynecologist,” says Candace Giles, DO, Nebraska Medicine obstetrician and gynecologist. “I have found that the vast majority of women who have a hysterectomy are very happy with the results because the surgery resolves many or all of the uncomfortable issues they experienced before surgery. Many say they wish they had done it sooner.”

What is a hysterectomy?

A total hysterectomy involves the removal of the uterus and the cervix. You will no longer be able to become pregnant after a hysterectomy. The fallopian tubes and ovaries may also be removed, depending on your age and risk factors. 

Removal of the ovaries causes surgical menopause if you have not already gone through natural menopause. 

“However, if you keep your ovaries, you will still produce estrogen and will experience menopause naturally,” says Dr. Giles. “The ovaries are usually only removed if you are at high risk for ovarian cancer or through shared decision-making with your doctor. Keeping the ovaries can offer health benefits, as it allows the body to continue producing estrogen. Estrogen production reduces the risk of bone loss, fractures and heart disease, as well as improvement in vaginal symptoms. Your healthcare provider will help determine what is best for you.”

Common reasons for performing a hysterectomy include: 

• Abnormal or heavy uterine bleeding.
• Uterine fibroids.
• Endometriosis.
• Severe pelvic pain.
• Cervical, ovarian or uterine cancer. 

Types of hysterectomy surgeries

If you are a candidate for a hysterectomy, your doctor will help determine whether a minimally invasive surgery or an abdominal hysterectomy is best for you. 

Abdominal hysterectomy

An abdominal hysterectomy involves a 6- to 8-inch incision made from the abdomen to the pubic bone or across the top of the pubic hairline. Dissolvable stitches, medical glue or tape are used to close the incision. This surgery usually requires a hospital stay of one to three days. 

Candidates for abdominal hysterectomy include those that have: 

• A very enlarged uterus.
• A very large tumor that needs to be removed.
• Significant scarring on the uterus and other pelvic organs.  
• Disease that has spread to other pelvic areas.

Types of minimally invasive hysterectomy surgery

There are several types of minimally invasive surgery that may be available. Depending on the approach, most patients go home the same day or after one night in the hospital.

These surgical techniques include:

Vaginal hysterectomy: Removal of the uterus through an incision at the top of the vagina.

Laparoscopic hysterectomy: A laparoscope is inserted near the belly button with additional small incisions in the lower abdomen to remove the uterus usually through the vagina. 

What to expect after surgery

Patients can expect:

• Vaginal bleeding and drainage for up to six weeks.
• Soreness or discomfort at the incision site.
• Tiredness from surgery.
• Slowing of bowels after anesthesia and surgery.  
• Burning during urination immediately after surgery due to catheter placement.
• Walking and urination within four to six hours after surgery.
• Prescription pain medications immediately after surgery, followed by over-the-counter options like nonsteroidal anti-inflammatory drugs or acetaminophen.
• Avoiding soaking in tub baths until cleared by your doctor.
• Walking and low-impact exercise to promote healing and recovery.
• A recovery period of four to six weeks after surgery, depending on the surgical method.

“Most women will notice significant positive changes, specifically with elimination of their heavy vaginal bleeding, pain or discomfort from their enlarged uterus,” says Dr. Giles. “You should also be able to return to normal sexual intercourse after full recovery and clearance from your doctor.”

Contact your doctor if you experience: 

• Worsening pain.
• Fever.
• Heavy vaginal bleeding.
• Persistent vomiting.

“These may be signs of a complication from the surgery, an infection or bowel problem and should be reported to your doctor immediately,” says Dr. Giles. “Complications are uncommon, and hysterectomies generally have very positive outcomes.”